I have a larger than average 11 year old (5’7" 130 pounds) who throws pretty hard… This past weekend, he threw 9 innings over 2 days (3 per game), striking out 19 and giving up 1 earned run in a 12U tournament. Threw well enough that the opposing coach in one of the games demanded to see his birth certificate thinking he was 13… He’s 18 months younger than the cutoff for the tournament, so that was good for a chuckle:-) After the last appearance yesterday, he complained of a little pain in in his elbow. He says the pain is on the boney knob on the inside of the elbow, I believe what’s called the medial epicondyle… I suspect the issue was a lack of proper stretching and pre-game warm up before the last game… I don’t coach on his 12U tourney team, and didn’t know he’d be starting that game (he did, just didn’t tell me), and I think he waited too long to get ready for the start because I wasn’t hounding him to quit relaxing with his buddies and get ready… Is this a reasonable conclusion, or should I be more worried?? Assuming his elbow is going to be fine (no pain today), I think I need to get him on a defined simple pre-game routine he can follow every time to make sure his arm is ready to throw. What would a proper pre game routine consist of??

Sounds more like possible overuse. Pitching in 3 games over 2 days is not recommended on its own simply because that’s 3 warm-up/cool-down cycles. Add in significant pitch counts (which you didn’t disclose) and its that much worse.

Back when I coached club ball, we tried to carry enough pitchers that no one had to pitch more than once over a 2-day tourney. For 3-day tournies, we’d let a pitcher throw on the 3rd day if they threw no more than about 25 pitches on the 1st day and none on the 2nd day. No pitcher pitched on consecutive days. And no pitcher pitched in multiple games on the same day unless he pitched the end of one game and the start of the next game where the games were back to back with little down time in between such that we could keep him warm (this was a very rare occurance).

You need to be careful with your son. The hardest throwers always get used the most.

Too much pitching…a well conditioned 11u shouldn’t throw more than 70-80 pitches in an outing. Then he should not pitch for the next four days. I didn’t say he shouldn’t throw as I believe that throwing the next day and the following days (easy, relaxed tossing) will speed recovery. My son’s a 5-5 130lb 12U who hits 65mph. We’ve followed what I outlined above and haven’t had an arm problem since he came down with LL shoulder after taking his 10U fall off from BB. You son should also be on a Throwers 10 program.

Throwing in multiple games in the same day is very tough on a young arm.
Especially for kids who can strike out a lot of other kids, their pitch counts tend to creep up pretty fast but seem effortless.
The throwers ten is a great suggestion, but it starts with managing him and keeping him from hurting himself.

Sounds like a textbook case of “Little League Elbow”, which is usually inflammation of the growth plate at the medial epicondyle. In severe cases, there can be a fracture of the growth plate at the medial epicondyle. In most cases these injuries are due to overuse, as noted by Roger. Overuse in a developing youth with open growth plates can take many forms: throwing year round without taking time off from throwing; too many pitches in a game; not taking sufficient days off from pitching after pitching in a game; pitching in two games on the same day; playing catcher and pitcher in the same game or on the same day; throwing curveballs too young; etc. You can’t leave your son’s arm health to his coaches. You need to inform yourself and protect him. First, you should take him to a sports orthopedic doctor to have his arm checked out. No throwing until the doctor clears him. Second, you should check out the “Pitch Smart” guidelines that Major League Baseball (yes, MLB) and USA Baseball have put out for youth pitchers and insist that your son follow them. Click on the “Pitch Smart” link below to see the guidelines. Keep in mind that each required “rest day” is a full calendar day, so if he throws enough pitches on Saturday to require a “rest day”, the “rest day” is Sunday, and he cannot pitch again until Monday.

Thanks for all the helpful information. Living in Wisconsin, taking time off during the year isn’t a problem… Basically takes August-February off every year while he plays football (no throwing) and wrestles… Throwing too much in a game hasn’t been a problem either… hit 85 on one instance, and got 6 days of rest from pitching. He only throws a 2 seam, 4 seam, and a second 2 seam “change up” with his grip just on the outside of the seam instead of inside as with the regular 2 seam… The things I need to address are overuse by pitching more than once in the same day, and how to get warmed up properly, cool down, and what to do regarding throwing between pitching outings. Throwers 10 is something I definitely need to get him going on, and need to have him do it year round. I had been going under the mistaken impression that as a big strong kid he could handle a little more load… The more I think about it I realize that being a power pitcher with a lot of K’s leads to more strain on his arm, even if he throws hard with less effort than a smaller kid does because he’s averaging more pitches per at bat. Thanks for all the great feedback everyone.

You also need to address, which you did not mention, his days of rest following each pitching outing. For his age (11) and for next year (12), according to the Pitch Smart guidelines, he will need a full 1 day of rest if he throws 21 pitches in a game; 2 days if he throws 36 pitches; 3 days if he throws 51 pitches; and 4 days if he throws 66 pitches (up to a daily max of 85).

Based on what you wrote, in his tournament this past weekend he averaged 2.1 strikeouts per inning. If he threw 3 innings on Saturday with 6-7 strikeouts, he had to have thrown at least 36 pitches (9 batters @ 4 pitches each). 36 pitches required that he have 2 days of rest (Sunday and Monday). Even if he threw 25 pitches over the 3 innings (unlikely with that many strikeouts), he still would have needed 1 day of rest (Sunday). Instead he got 0 days of rest, pitching the very next day, Sunday. And, if he threw 6 innings on Saturday with 12-13 strikeouts, he had to have thrown at least 72 pitches (18 batters @ 4 pitches each). 72 pitches required that he have 4 days of rest. Instead he got 0 days of rest, pitching the very next day, Sunday. Any way you slice and dice that weekend, he was overused.

All that I have read above is good and helpful. What I found helped me a lot was to stretch out before throwing a pitch by jogging, sliding, then arm circles, and then stretching all parts of my arm and slowly working into throwing harder. I usually throw more comfortably, harder, and accurately when I get a good stretch in. At the same time over work is not good for anybody.

It’s good to just keep stretching the muscles throughout, even your son is just waiting for a catcher to throw the ball back him if he feels like something might hurt/ache a bit, stretch out.